Ronald Alan Mudry Jr., MD

Primary specialty

Pulmonary Disease PhysicianTaxonomy code 207RP1001X

License

21547 Issued in WV

Practice address

911 Gorman Ave
Suite 201
Elkins, WV 26241-3082

Phone

(304) 637-6302

Fax

(304) 637-6307

NPI assigned

Sep 11, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in WV

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Internal Medicine

Education

West Virginia University School of Medicine, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

St George Medical Clinic IncGroup PAC ID 7911996244, 15 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Davis Medical Center Hospital, Elkins, WV, CCN 510030

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• St. George Medical Clinic Inc.

  • Federally Qualified Health Center (FQHC)
  • Parsons, WV
  • NPI 1497853600
  Medicare reassignment Care Compare group NPD
• St George Medical Clinic Inc

  • Pharmacy
  • Davis, WV
  • NPI 1326796822
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Davis Memorial Hospital

  • General Acute Care Hospital
  • Elkins, WV
  • NPI 1619964806
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1157932800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1414368000000",
    "number": "1710081864",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2630",
            "city": "ELKINS",
            "state": "WV",
            "postal_code": "262412630",
            "telephone_number": "304-637-6302",
            "fax_number": "304-637-6307"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "911 GORMAN AVE",
            "address_2": "SUITE 201",
            "city": "ELKINS",
            "state": "WV",
            "postal_code": "262413082",
            "telephone_number": "304-637-6302",
            "fax_number": "304-637-6307"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MUDRY",
        "first_name": "RONALD",
        "middle_name": "ALAN",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-11",
        "last_updated": "2014-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WV",
            "license": "21547",
            "primary": false
        },
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "WV",
            "license": "21547",
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "WV",
            "license": "21547",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MOUNTAIN STATE BCBS",
            "identifier": "1710081864",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810008329",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PLAN",
            "identifier": "WV21547A",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mountaineer Pulmonology, PLLC
• Samantha Mouser
• Ida Moyer
• Mary Jo Moyer
• Amanda Moyers
• Mujib Rahman MD Medical Clinic
• Briana Nate Mullenax
• Deborah Lynn Mullenex
• Kayla Mullennex
• Susan Lynn Mullens, MS LPC NCC ALPS CCAC

• Pulmonary Disease Physician in Elkins, WV
• Providers in Elkins, WV by specialty
• Pulmonary Disease Physician in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.